Breast augmentation involves placement of a silicone gel or saline implant under the breast tissue or under the pectoralis muscle, to enlarge the breasts or help with breasts which droop due to loss of breast volume. This frequently occurs after one or more pregnancies.
In my experience, placement of the implants under the muscle, allows for the most natural appearance without the “stuck on the chest” look. It also allows for better mammography and has a reduced incidence of capsular contraction (the breasts becoming firm post-operatively). The incision at the inferior portion of the areola, which is at the junction of the areola (the pigmented skin) and the skin, gives a scar that blends in beautifully and is usually very difficult to see. Generally, the silicone gel implants are lighter, softer, and feel and move much more like normal breast tissue than the saline implants.
Obviously, it is important to achieve the size that the patient is envisioning. Bra cup size is extremely inaccurate, so it’s much better to work from photographs of semi-nude models, and ask the patient some very specific questions regarding their goals in relationship to the photograph. This allows the surgeon to give the patient the breast size that they are seeking.
The key to a beautiful augmentation is a smooth and even breast pocket on the chest wall and the placement of the optimal implants to meet the patient’s goals. The results should be pretty and very natural in appearance.